EVIL WEED OR USEFUL DRUG?

The Pros And Cons Of Medical Marijuana

Marcy Duda, a former home health aide with four children and two
granddaughters, never dreamed she'd be publicly touting the medical
benefits of "pot.''

But marijuana, says the 48-year-old Ware resident, is the only thing
that even begins to control the migraine headaches that plague her
nine days a month, which she describes as feeling like "hot, hot ice
picks in the left side of my head.''

Duda has always had migraines. But they got much worse 10 years ago
after two operations to remove life-threatening aneurysms, weak areas
in the blood vessels in her brain. None of the standard drugs her
doctors prescribe help much with her post-surgical symptoms, which
include nausea, vomiting, loss of appetite, and pain on her left side
"as if my body were cut in half.''

With marijuana, however, "I can at least leave the dark room,'' she
says, "and it makes me eat a lot of food.''

The culture wars over marijuana, for recreational and medical use,
have been simmering for decades, with marijuana (cannabis) still
classified (like heroin) as a Schedule I controlled substance by the
US government, meaning it has no approved medical use. (There is a
government-approved synthetic form of marijuana called Marinol
available as a prescription pill for treating nausea, vomiting, and
loss of appetite, though advocates of the natural stuff say it is not
as effective as smoked pot.)

Some, like David Evans, special adviser to the nonprofit Drug Free
America Foundation of St. Petersburg, Fla., applaud the government's
view, saying marijuana has not gone through a rigorous US Food and
Drug Administration approval process.

But that skepticism frustrates leading marijuana researchers like Dr.
Donald Abrams, a cancer specialist at San Francisco General Hospital.

"Every day I see people with nausea secondary to chemotherapy,
depression, trouble sleeping, pain,'' he says. "I can recommend one
drug [marijuana] for all those things, as opposed to writing five
different prescriptions.''

The tide seems to be turning in favor of wider medical use of
marijuana. The Obama administration announced in March that it will
end the Bush administration's practice of frequently raiding
distributors of medical marijuana. Thirteen states, including Vermont,
Rhode Island, and Maine, now allow medical use of marijuana, according
to Bruce Mirken, spokesman for the Marijuana Policy Project, which
advocates legalization of pot. Last week, however, New Hampshire
Governor John Lynch vetoed legislation that would have legalized
medical marijuana in that state.

Research on medical marijuana is hampered by federal regulations that
tightly restrict supplies for studies. But there is a growing body of
studies, much of it supportive of the drug's medical usage, though
some of it cautionary. Given the intense politics involved, it's true,
as Abrams puts it, that "you can find anything you want in the medical
literature about what marijuana does and doesn't do.''

With that in mind, here's an overview of what the research says about
the safety and effectiveness of using marijuana to treat various ailments.

Pain: Marijuana has been shown effective against various forms of
severe, chronic pain. Some research suggests it helps with migraines,
cluster headaches, and the pain from fibromyalgia and irritable bowel
syndrome because these problems can be triggered by an underlying
deficiency in the brain of naturally-occurring cannabinoids,
ingredients in marijuana. Smoked pot also proved better than placebo
cigarettes at relieving nerve pain in HIV patients, according to two
recent studies by California researchers. Marijuana also seems to be
effective against nerve pain that is resistant to opiates.

Cancer: The active ingredients in cannabis have been shown to combat
pain, nausea, and loss of appetite in cancer patients, as well as
block tumor growth in lab animals, according to a review article in
the journal Nature in October 2003. But there's vigorous debate about
whether smoking marijuana increases cancer risk.

Some studies that have looked for a link between cancer risk and
marijuana have failed to find one, including a key paper from the
University of California-Los Angeles and the University of Southern
California published in 2006. "We had hypothesized, based on prior
laboratory evidence, including animal studies, that long-term heavy
use of marijuana would increase the risk of lung and head and neck
cancers,'' said Hal Morgenstern, a coauthor and an epidemiologist at
the University of Michigan School of Public Health. "But we didn't get
any evidence of that, once we controlled for confounding factors,
especially cigarette smoking.''

Research published by a French group this year and by Kaiser
Permanente, a California-based HMO, in 1997 came to a similar conclusion.

But a state health agency in California, the first state to legalize
marijuana for medical use in 1996, recently declared pot smoke (though
not the plant itself) a carcinogen because it has some of the same
harmful substances as tobacco smoke. The active ingredient in
marijuana can increase the risk for Kaposi's sarcoma, a common cancer
in HIV/AIDS patients, Harvard researchers reported in the journal
Cancer Research in August 2007. And British researchers reported in
May 2009 in Chemical Research in Toxicology that laboratory
experiments showed that pot smoke can damage DNA, suggesting it might
cause cancer.

The federal government's National Institute on Drug Abuse says that it
is "not yet determined'' whether marijuana increases the risk for lung
and other cancers.

Respiratory problems: Smoking one marijuana joint has similar adverse
effects on lung function as 2.5 to 5 cigarettes, according to a New
Zealand study published in Thorax in July 2007. A small Australian
study published in Respirology in January 2008 showed that pot smoking
can lead to one type of lung disease 20 years earlier than tobacco
smoking.

Addictive potential: The National Institute on Drug Abuse says
"repeated use could lead to addiction,'' adding that some heavy users
experience withdrawal symptoms such as irritability and sleep loss if
they stop suddenly.

Mental effects: Cannabis may increase the risk of psychotic disorders,
according to a 2002 study in the American Journal of Epidemiology. And
the national drug abuse agency warns that "heavy or daily use of
marijuana affects the parts of the brain that control memory,
attention, and learning.'' A study of 15 heavy pot smokers published
in June 2008 in the Archives of General Psychiatry showed loss of
tissue in two areas of the brain, the hippocampus and amygdala,
regions that are rich in receptors for marijuana and that are
important for memory and emotion, respectively.

Vaporizing vs. smoking: The push now among proponents of medical
marijuana is toward inhaling the vapor, not smoking. Vaporizing is a
safe and effective way of getting THC, the active ingredient, into the
bloodstream and does not result in inhalation of toxic carbon
monoxide, as smoking does, according to a study by Abrams published in
2007 in Clinical Pharmacology and Therapeutics.

Bottom line: From a purely medical, not political, point of view, my
take is that if I had medical problems that other medications did not
help and that marijuana might, I'd try it - in vaporized form.

Just as Marcy Duda does. "You use it as you need it. You can be
normal. You can function,'' she says. "I don't get high. I get by.''

[sidebar]

Massachusetts marijuana laws

Massachusetts does not allow medical marijuana, but the Legislature's
public health committee held hearings on a bill this spring that would
allow patients with specified conditions to use marijuana with written
certification from a physician or other practitioner licensed to
prescribe controlled substances.

Last year, voters approved ballot Question 2, which removed the
possibility of jail for simple marijuana possession. Now, possession
of an ounce or less is punishable by only a $100 fine and forfeiture
of the marijuana. That ballot initiative did nothing to change the law
regarding drug paraphernalia - such as the machines that vaporize
marijuana. This means that vaporizers are "probably'' still illegal,
says Michael Cutler, a lawyer.